The diagnostic accuracy of screening for psychosis spectrum disorders in behavioral health clinics integrated into primary care.

Screening for psychosis spectrum disorders in primary care could improve early identification and reduce the duration of untreated psychosis. However, the accuracy of psychosis screening in this setting is unknown. To address this, we conducted a diagnostic accuracy study of screening for psychosis spectrum disorders in eight behavioral health services integrated into primary care clinics. Patients attending an integrated behavioral health appointment at their primary care clinic completed the Prodromal Questionnaire - Brief (PQ-B) immediately prior to their intake assessment. This was compared to a diagnostic phone interview based on the Structured Interview for Psychosis Risk Syndromes (SIPS). In total, 145 participants completed all study procedures, of which 100 screened positive and 45 negative at a provisional PQ-B threshold of ≥20. The PQ-B was moderately accurate at differentiating psychosis spectrum from no psychosis spectrum disorders; a PQ-B distress score of ≥27 had a sensitivity and specificity of 71.2 % and 57.0 % respectively. In total, 66 individuals (45.5 %) met criteria for a psychosis spectrum disorder and 24 (16.7 %) were diagnosed with full psychosis, indicating a high prevalence of psychosis in the sample. Overall, screening for psychosis spectrum disorders in an IBH primary care setting identified a relatively high number of individuals and may identify people that would otherwise be missed. The PQ-B performed slightly less well than in population-based screening in community mental health settings. However, the findings suggest this may represent an effective way to streamline the pathway between specialty early psychosis programs and primary care clinics for those in need.

Effect of Technology-Enhanced Screening in Addition to Standard Targeted Clinician Education on the Duration of Untreated Psychosis: A Cluster Randomized Clinical Trial.

Importance: Reducing the duration of untreated psychosis (DUP) is essential to improving outcomes for people with first-episode psychosis (FEP). Current US approaches are insufficient to reduce DUP to international standards of less than 90 days. Objective: To determine whether population-based electronic screening in addition to standard targeted clinician education increases early detection of psychosis and decreases DUP, compared with clinician education alone. Design, Setting, and Participants: This cluster randomized clinical trial included individuals aged 12 to 30 years presenting for services between March 2015 and September 2017 at participating sites that included community mental health clinics and school support and special education services. Eligible participants were referred to the Early Diagnosis and Preventative Treatment (EDAPT) Clinic. Data analyses were performed in September and October 2019 for the primary and secondary analyses, with the exploratory subgroup analyses completed in May 2021. Interventions: All sites in both groups received targeted education about early psychosis for health care professionals. In the active screening group, clients also completed the Prodromal Questionnaire-Brief using tablets at intake; referrals were based on those scores and clinical judgment. In the group receiving treatment as usual (TAU), referrals were based on clinical judgment alone. Main Outcomes and Measures: Primary outcomes included DUP, defined as the period from full psychosis onset to the date of the EDAPT diagnostic telephone interview, and the number of individuals identified with FEP or a psychosis spectrum disorder. Exploratory analyses examined differences by site type, completion rates between conditions, and days from service entry to telephone interview. Results: Twenty-four sites agreed to participate, and 12 sites were randomized to either the active screening or TAU group. However, only 10 community clinics and 4 school sites were able to fully implement population screening and were included in the final analysis. The total potentially eligible population size within each study group was similar, with 2432 individuals entering at active screening group sites and 2455 at TAU group sites. A total of 303 diagnostic telephone interviews were completed (178 [58.7%] female individuals; mean [SD] age, 17.09 years [4.57]). Active screening sites reported a significantly higher detection rate of psychosis spectrum disorders (136 cases [5.6%], relative to 65 [2.6%]; P < .001) and referred a higher proportion of individuals with FEP and DUP less than 90 days (13 cases, relative to 4; odds ratio, 0.30; 95% CI, 0.10-0.93; P = .03). There was no difference in mean (SD) DUP between groups (active screening group, 239.0 days [207.4]; TAU group 262.3 days [170.2]). Conclusions and Relevance: In this cluster trial, population-based technology-enhanced screening across community settings detected more than twice as many individuals with psychosis spectrum disorders compared with clinical judgment alone but did not reduce DUP. Screening could identify people undetected in US mental health services. Significant DUP reduction may require interventions to reduce time to the first mental health contact. Trial Registration: ClinicalTrials.gov Identifier: NCT02841956.

Health Literacy, Social Networks, and Health Outcomes among Mental Health Clubhouse Members in Hawai'i.

Health literacy is the ability to obtain and utilize health information to make health-related decisions and to navigate health systems. Although health literacy has traditionally been understood as an individual-level construct, current research is revealing the impact that social networks can have on health literacy. To date, no studies have examined associations between health literacy and social networks among people with serious mental illness (PWSMI), who are at high risk of physical illness and premature mortality. To begin to fill this gap, this study explores associations between health literacy, relationships with health discussion partners, and self-reported health outcomes in a racially diverse sample of Clubhouse members in Hawai'i. Clubhouses are community mental health centers that promote recovery from mental illness through destigmatization, meaningful activity, and strong social relationships. Health literacy was assessed using two single-item screeners (SILS). In a sample of 163 members, 56.2% reported adequate ability to understand health-related instructions or pamphlets, and 43.3% reported adequate confidence filling out medical forms independently. This is consistent with other health literacy studies with PWSMI in the United States, and indicates lower health literacy within this group than is reported in national averages. Multivariate logistic regression revealed a larger Clubhouse staff social network and completing high school were significantly associated with requiring less help to read materials. Higher age, male gender, and being Native Hawaiian and/or Pacific Islander were associated with less confidence filling out medical forms, while higher self-efficacy was associated with higher confidence filling out medical forms. This study provides preliminary evidence that relationships fostered within Clubhouses are associated with health literacy among PWSMI, and highlights the need for more research to examine how social networks and health literacy interventions can be leveraged in community mental health settings to improve health outcomes within this vulnerable population.

Mapping community: A scoping review of clubhouse members' social networks and their impact on recovery in mental illness.

OBJECTIVE: Social support is an important component of recovery-based interventions for individuals living with severe mental illness (IWSMI). Clubhouses are local community centers that facilitate the development of meaningful relationships among IWSMI through an empowering structure and engagement with the work-ordered day. This review synthesizes research on social networks in Clubhouses to provide insights on the role of supportive relationships in mental illness recovery, including the size and features of social networks of Clubhouse members, methodological trends and gaps, and the associations between social networks and demographic variables, recovery, health, and perceived social support. METHOD: Research on social networks within Clubhouses were identified and analyzed following a systematic six-stage scoping review design. RESULTS: Twelve articles across six studies were included. Results revealed considerable variation in social network interview methods and network size and features. Overall findings suggest that network size is not consistently associated with reported loneliness, social support, recovery, or quality of life. A deep relationship with at least one supportive person, level of perceived affiliation with Clubhouses, or positive comments from network members may be more or equally valuable than a larger network. Some studies found that types of relationships were associated with unique benefits. Stronger peer networks were associated with relationship satisfaction, while increased connections with health care professionals and family were associated with reduced hospitalizations. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Future research should diversify research designs, expand the use of social network analysis and visualization, measure additional outcomes including recovery and health, and increase sample diversity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Momentary assessment of aberrant salience, anomalous self-experiences, and psychotic-like experiences.

To improve understanding of emerging psychosis, researchers have identified potential precursory mechanisms that may momentarily precede psychotic-like experiences, including aberrant salience and anomalous self-experiences. Aberrant salience is the misattribution of significance to neutral stimuli and may be linked to atypical dopamine transmission. Anomalous self-experiences include changes in the experience of the self, which may alter top-down cognitive processes. The present study extends previous research on these phenomena by examining the momentary dynamics of aberrant salience, anomalous self-experiences, and psychotic-like experiences in daily life. Participants were 246 young adults who were prompted to complete 6 smartphone surveys daily for 7 days. Baseline measures of aberrant salience and anomalous self-experiences each predicted occurrence of the same phenomena in daily life, supporting the use of these measures to examine within-subject changes. Dynamic structural equation modeling was used to examine lagged effects. Both aberrant salience and anomalous self-experiences exhibited carryover effects across timepoints. Furthermore, aberrant salience and anomalous self-experiences were each associated with psychotic-like experiences at subsequent timepoints, above and beyond the carryover effects of psychotic-like experiences. These temporal relationships provide preliminary support consistent with social-cognitive models of psychosis and support further examination of the within-subject dynamics of aberrant salience and anomalous self-experiences at the momentary scale. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Contributions of childhood trauma and atypical development to increased clinical symptoms and poor functioning in recent onset psychosis.

AIM: The trauma-psychosis cycle proposes an interactive relationship between impaired developmental and cognitive trajectory, childhood trauma exposure, and increased risk for psychosis. This study explored how childhood trauma (CT) and atypical development (AD) impact clinical course in an early psychosis cohort. METHODS: A retrospective chart review of behavioural and clinical research data was conducted with individuals ages 12 to 40 (N = 508; 72.4% males) evaluated by an early psychosis program. RESULTS: CT exposure was associated with earlier onset of full threshold psychosis, more hospitalizations, higher ratings of negative symptoms, and increased likelihood of engaging in suicidal behaviour. AD alone was associated with earlier onset of psychosis symptoms, higher ratings of negative symptoms and greater likelihood of engaging in non-suicidal self-injury. The combination of CT and AD was associated with the earliest symptom onset and poorest psychosocial functioning. CONCLUSIONS: The findings contribute to our understanding of heterogeneity in the early psychosis population and highlight the specific risk factors that could be targets in treatment.

Differential item functioning of the Multidimensional Schizotypy Scale and Multidimensional Scale-Brief across ethnicity.

Schizotypy refers to traits or symptoms similar to schizophrenia, but in a diminished form, and schizotypy is thought to reflect a liability for the future development of schizophrenia. The Multidimensional Schizotypy Scale (MSS) is a new measure of schizotypy that improves on existing measures. The MSS contains full and brief subscales for positive, negative, and disorganized schizotypy. Although MSS scores have been validated in a variety of populations, the scales have not been thoroughly examined for differential item functioning in East Asian, Southeast Asian, Hispanic, Multiracial, and White participants. The current study included 567 East Asian, 351 Southeast Asian, 360 Hispanic, 230 Multiracial, and 345 White undergraduate participants from the United States. Overall, few of the items in the full or brief versions of the scales displayed differential item functioning across groups. The full and brief versions of the scales also displayed similar and not-significantly different validity coefficients with the Detachment and Psychoticism scales of the Personality Inventory for DSM-5. These findings suggest that the MSS measures the same constructs across ethnic groups, and the scale scores represent the same latent level of schizotypy among groups. Future research may use the MSS in these diverse groups without concern that the psychometric properties differ significantly among groups. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychosis screening in schools: Considerations and implementation strategies.

AIM: Duration of untreated psychosis, or the time between onset of psychosis symptoms and accurate diagnosis and treatment, is a significant predictor of both initial treatment response and long-term outcomes. As such, efforts to improve rapid identification are key. Because early signs of psychosis commonly emerge in adolescence, schools have the potential to play an important role in the identification of psychosis-spectrum disorders. METHODS: To illustrate the potential role of schools in this effort, the current paper describes implementation of a psychosis screening tool as part of a larger study focused on reducing the duration of untreated psychosis in Sacramento, CA. RESULTS: Clinical considerations related to screening for psychosis in schools, including ethical concerns, logistics, screening population and stigma are addressed. Implementation strategies to address these concerns are suggested. CONCLUSIONS: Early psychosis screening in the school system could improve early identification, reduce stigma and may represent an important further step towards an integrative system of mental health.

Clinical and neurodevelopmental correlates of aggression in early psychosis.

BACKGROUND: Although mental illness accounts for only 4% of aggressive behavior in the general population, there remains a modest association between aggressive behavior and psychotic disorders, particularly in the early stages of the illness. However, little is known about the specific factors associated to this increased risk. AIMS: The present study aims to assess the rates, characteristics and risk factors of aggressive behavior in first episode psychosis patients (FEP). METHOD: We conducted a retrospective chart review of 449 FEP patients recruited from an outpatient early psychosis clinic. Aggressive behavior and clinical information were rated based upon information gathered from the chart review of data collected at baseline and after 6 months of follow-up. RESULTS: Rates of aggressive behavior were 54.3% in FEP patients. Aggressive behavior was significantly associated with higher rates of history of birth complications, neurodevelopmental delays, learning difficulties, alcohol use disorders, and the clinical domain of poverty symptoms. In addition to aggressive behavior, 16.7% of FEP patients exhibited suicidal ideation or behaviors and 11.4% exhibited non-suicidal self-injurious behavior (NSSIB). In contrast to baseline, aggressive behaviors at 6 months follow up were almost entirely absent. CONCLUSIONS: Patients at early stages of psychosis have high rates of aggressive and suicidal behavior prior to contact with clinical services. Neurodevelopmental adversities, alcohol use disorders and poverty symptoms are associated to higher risk of aggression in early psychosis. Participation in early psychosis specialty care resulted in a dramatic reduction in aggressive behavior.